L4- Inequalities and inequities

Question 1

Social determinants of health

Answer 1

Are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

Question 2

In areas of most sickness and death:

Answer 2

GPS have more work, larger lists, less hospital support and inherit more clinically ineffective traditions of consultation than in the healthiest areas

Hospital doctors should heavier case loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in bed availability

Question 3

Inverse Care Law:

Answer 3

These trends can be summed up as the inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served

Question 4

how health is measured

Answer 4

Mortality and life expectancy

Self- report (e.g surveys)

Broad questions

Question 5

Inequalities in health are not only related to socioeconomic factors- but also with diversity

Answer 5

Relationships between factors are complex

Health of each individual patient is related to socioeconomic status (and the constraints within which they live), ethnicity, gender and age

Question 6

health and social class

Answer 6

Deprivation strongly associated with ill health: - The more deprived a person is the larger the proportion of their life will be spent in ill health and more likely to die at a younger age

Question 7

Health and gender

Answer 7

‘Men die quicker, but women get sicker’

Men

Mean

• Lower life expectancy
  
  • More CVD e.g. heart attacks
  • More suicide
  • More violent death

Women

• Higher life expectancy
• Higher reported (poor) mental health

Higher rates of disability and limiting longstanding illness

Question 8

health and ethhnicity

Answer 8

• culture- ways of being/doing
• access to/ exclusion from sevreices/resources
• genetic factors

Question 10

Explanations, theories and pathways for health inequalities (6)

Answer 10

1. Artefact (discredited)
2. Social selection
3. Behavioural-cultural
4. Materialist (most plausible)
5. Psychosocial
6. Income distribution

Question 11

1.Artefact explanation

Answer 11

Health inequalities evident due to the way statistics are collected (re measurement of class)

Question 12

Artefact explanation

-Concerns about quality of data and method of measurement: Numerator

Answer 12

based on occupational distribution of those who die during the period considered

Question 13

Artefact explanation

-Concerns about quality of data and method of measurement: denominator

Answer 13

occupational distribution at the most recent cencus

Question 14

Social selection explanation

Answer 14

• Sick individuals move down social hierarchy, healthy individuals move up
• Chronically ill and disabled more likely to be disadvantaged
• Plausible explanation

Question 15

Behaviour-cultural explanation

Answer 15

Ill health due to peoples choices/ decisions, knowledge and goals.

Question 16

limitations of behaviour- cultural explanation

Answer 16

• Behaviours are outcomes of social processes, not simply individual choice
• Choices may be difficult to exercise in adverse conditions
• Choices may be rational for those who lives are constrained by lack of resources

Question 17

Materialist explanation

Answer 17

Lack of choice in exposure to hazards e.g. radiation

Accumulation of factors across life course

Most plausible

Question 18

which explanation is most plausible

Answer 18

materialist explantion

Question 19

limitations of materialist explanation

Answer 19

Limitations:

Further research needed as to precise routes through which material deprivation causes ill-health

Question 20

Psychosocial explanation

Answer 20

• Health influenced more by differences in income than actual income
• Some stressors are distributed on a social gradients e.g. negative life events, social support, autonomy at work and job security
• Stress impacts on health via different pathways

Question 21

Stress impacts on health via different pathways

Answer 21

Direct- physiological and immune system

Indirect- mental health

Question 22

Income Distribition (Wilkinson)

Answer 22

• Relative (not average) income affects health
• Countries with greater income inequalities have greater health inequalities
• It is not the richest, but the most egalitarian societies that have the best health

Question 23

Larger the income gaps within a country, the worst the country performs on these health and social problems.

WHY?

Answer 23

Psychosocial explanation

Redistributive policies: reducing income inequality in a society can improve social well-being and in in turn many other health and social factors

Question 24

what can eb done to stop inequalities and inequities

Answer 24

1. Strengthening individuals
2. Strengthening communities
3. Improving living and working conditions
4. Promoting health macro policies

Question 25

Inequity-

Answer 25

inequity refers to unfair, avoidable differences arising from poor governance, corruption or cultural exclusion

Question 26

Inequality-

Answer 26

inequality simply refers to the uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources

Question 27

you can have inequality

Answer 27

without inequity

Question 28

Inequities in Access to healthcare

More deprived groups seem to have:

Answer 28

Higher rates of use of

• GP services
• Emergency services

Under-use of

• Preventative services (screening, asthma, outpatients)
• Specialist services (cancer treatment)

Question 29

Deprived peoples health is usually managed a

Answer 29

as series of crises (i.e. they don’t go to the doctor until they are very unwell)

Normalisation of ill-health

Question 30

solution to deprivation and access

Answer 30

Event based counsellin

Question 31

events based counselling

Answer 31

Event based counselling (i.e. at a food bank or walk in clinic at homeless shelters) may be needed to legitimise consultation

• These events are expensive- difficult marshalling resources needed for negotiation and engagement with health services.
• Due to lack of cultural alignment between health and service and lower socio-economic groups

Question 32

name some social determinants of health and illness

Answer 32

Social class, ethnicity, gender and deprivation

Question 33

Inequality and inequity in health and healthcare access are significant contributors

Answer 33

to (ill)health in Britain